Annals of Internal Medicine tip sheet for Oct. 23, 2012

The United States Preventive Services Task Force recommends against the use of estrogen and progestin for the prevention of chronic medical conditions in postmenopausal women and the use of estrogen alone for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy. Following a review of 51 articles published since 2002, the Task Force concluded that risks associated with these hormone replacement therapies (HRT) outweigh the chronic disease prevention benefits. The Task Force found that both estrogen alone and estrogen plus progestin reduce the risk for fractures, but increase risk for stroke, thromboembolic events, gallbladder disease, and urinary incontinence. Estrogen alone decreased risk for breast cancer. Estrogen plus progestin increased risk for probable dementia and breast cancer. The risk for breast cancer increased for women with prior oral contraceptive use, prior menopausal estrogen plus progestin therapy, or current smoking. The recommendations apply to average-risk women who have undergone menopause, and are not about the use of hormone therapy to treat symptoms of menopause, such as hot flashes or vaginal atrophy. These recommendations match the Task Force's 2005 recommendations on HRT.

Note: For a PDF of the article, please contact Megan Hanks or Angela Collom. For an interview with an author, please contact Ana Fullmer at ana.fullmer@edelman.com or 202-350-6668.

The authors of three separate editorials discuss the presidential candidates' positions on healthcare, and how the winner will influence the nation's care.

David Blumenthal, MD, MPP, Chief Health Information and Innovation Officer at Partners Health System in Boston authored the first editorial. According to Dr. Blumenthal, voters should be focused on health care even more so than the economy, as the next president will profoundly influence the future of the country's health care system. Dr. Blumenthal calls the 2012 presidential election "the most important health care election in the history of the Republic." He focuses on the importance of covering currently uninsured Americans.

In the second editorial, Robert Berenson, MD, a senior fellow at the Urban Institute in Washington, D.C. explains how health care could change under a Democratic or Republican president. While the Affordable Care Act will provide currently uninsured patients with regular and continuous care from their selected clinicians, the shortage of primary care physicians may bulk under the weight of increased patient volume. Dr. Berenson also discusses the need to revise the current reimbursement system so that health care providers are paid for "value" and not "volume."

Gail Wilensky, PhD, an economist and senior fellow at Project Hope in Bethesda, MD, authored the third editorial, focusing on how the election will impact physicians. In addition to reduced Medicare fees, primary care physicians will be faced with a large workload increase as more patients are insured. According to the author, there are important differences between the candidates' approaches to expanding coverage and slowing spending, but the most important issue is how to fix the Resource-Based Relative Value Scale reimbursement system and how to handle the mandatory cuts to Medicare.

Note: For a PDF of the editorials, or for interview information, please contact Megan Hanks or Angela Collom. For Dr. Blumenthal, please contact Rich Copp at rcopp@partners.org or 617-278-1031. For Dr. Berenson, please contact Stu Kantor at skantor@urban.org or 202-261-5283. For Dr. Wilensky, please contact Rand Walton at rwalton@projecthope.org or 540-837-9469.

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